How aggressively should we diurese patients admitted for CHF? Dr. Smith shares this piece which suggests we should be aggressive! Robust diuresis in the first 48 hours is associated with:
⬇️ dyspnea
⬇️ creatinine (up to ~3.5L)
⬇️ odds of 60‐day rehospitalization or death
#SoHM23
Although it's built into every admission order set across EMRs, tylenol for fever isn't necessary. Dr. Smith shares this recent systematic review & meta-analysis which showed no improvement in mortality nor adverse effects when giving tylenol for fever.
#SoHM23
#TWDFNR
Being NPO is hard. (Particularly timely to discuss right before lunch!) Dr. Smith discusses the recent article in @JHospMedicine looking at ways to ⬇️ NPO past MN orders.
🔵 Being intentional about who really needs to be NPO can reduce unnecessary NPO status for many!
#SoHM23
First up, Dr. Smith shares this recent study comparing IV hydromorphone vs IV acetaminophen for acute pain tx.
🔵Both medications helped reduce pain!
🔵Hydromorphone was slightly better.
🔵Fewer adverse effects with acetaminophen.
#SoHM23
Updates in #HospitalMedicine is always one of the highlights of our conference. Dr. Dustin Smith kicks off our 2nd version of that for this year now!
#SoHM23
We're wrapping up our plethora of pulmonary problems with recent updates in the GINA Guidelines for the management of asthma!
🔥🔥🔥 Patients w/asthma should NOT receive only prn albuterol! Replace prn albuterol w/ prn ICS-formoterol!🔥🔥🔥
#SoHM23
Dr. Bonsall wraps up our discussion on PNA with recommendations about treatment duration and discharge ABX options.
🔵General CAP tx is 5 days!
#SoHM23
Which ABX is right for your patient with CAP? Dr. Bonsall shares current guidelines to help guide this decision!
#SoHM23
Are you on team procal? Dr. Bonsall shares data w/ key recommendations:
🔵Possible use in pts when you may need a prolonged ABX course
🔵Possible use in helping w/ decision to NOT use ABX in pts with less-severe COVID-19
🔵Possible use in ABX stewardship efforts
#SoHM23
Grady #HospitalMedicine Director Dr. Joanna Bonsall shares 2019 IDSA/ATS guidelines on diagnostic testing for patients admitted w/ CAP. Questions to consider:
Risk of MRSA or GNR? ➡️ sputum cx, blood cx, MRSA swab
Do they have severe CAP? Add Legionella & pneumococcal UAT
#SoHM23
Dr. Dressler wraps up our COPD discussion with data on NIPPV.
🔵 For patients with pH <7.35 and PCO2 45, NIPPV is recommended!
🔵Improves mortality, NNT 12
🔵Reduces Intubations, NNT 5
🔵Reduces Hospital LOS, >3 days on average
#SoHM23
Steroids for COPD exacerbations are vital! Dr. Dresslers shares 2023 GOLD guidelines:
prednisone 40 mg/day x 5 days
🔵⬇️Shorten recovery time
⬆️ FEV1
⬇️hypoxemia
⬇️relapse, treatment failure and hospital LOS*
🔵Oral as good as (possibly better than) IV
#SoHM23
We often give ABX to patients with COPD exacerbations, but what do the guidelines recommend? Dr. Dressler shares the 2023 GOLD guidelines, which recommend a 5-7 day course, as well as recent literature that suggests shorter courses (2 days!) may be an option for some.
#SoHM23
Do you check a CRP when caring for patients admitted for COPD exacerbation? Recent literature suggests that for less ill hospitalized patients, CRP-guided therapy may help you decrease ABX without incurring harm.
#SoHM23
For patients with COPD exacerbations, Dr. Dressler explains that procalcitonin does not seem to have a significant benefit and increases the risk of death for patients in the ICU.
#SoHM23
First up: for patients with a COPD exacerbation, should you order a VBG or ABG? Dr. Dressler shares this item from @SocietyHospMed's The Hospitalist written by several of our Emory faculty:
🔵VBGs approximate ABGs well for pH but not for pCO2
#SoHM23
Dr. McDaniel explains that you should avoid morphine in ACS. It decreases intestinal absorption of antiplatelet meds and is associated with ⬆️ death.
#SoHM23
Dr. McDaniel discusses the data for heparin vs LMWH. There's no benefit to one vs the other and IV heparin is easier to manage, so this tends to be preferred in the cath lab.
#SoHM23
Dr. McDaniel shares data on the sometimes controversial decision about whether to give patients w/a STEMI GP iib/iiia inhibitors. There is ⬇️ mortality and MI but ⬆️ bleeding. Guidelines suggest giving this medication should be considered.
#SoHM23
Welcome back, y'all! We are looking forward to a packed 2nd day here at #SoHM23! Dr. McDaniel is getting us started with updates in management for Acute Coronary Syndrome! 🫀
We are looking forward to our next round of incredible speakers! Grab some coffee and snacks in the exhibitor hall and join us for more learning!
#SoHM23
We are back from lunch and ready to go! We've got 4 tracks running simultaneously on a variety of #HospitalMedicine topics. Let's get started!
#SoHM23
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Dr. Anderson shares data that has evolved since 2015 demonstrating that thrombectomy can have great impact for appropriately selected patients with strokes!
#SoHM23
We are thrilled to welcome an incredible #HospitalMedicine leader & our 1st keynote speaker, Dr. Kierstin Kennedy, to our meeting! She will share her presentation, "Evolution of Quality, Patient Safety and Leadership in Hospitals." Thank you for joining us,
@OhHeyDrKay!
#SoHM23
Dr. Kennedy reviewed the evolution of quality improvement over the last century including interventions from The Joint Commission, the IHI, and the WHO. She asked the audience what is missing from QI in healthcare.
#SoHM23
Dr. Sevransky explains that norepi remains the first line vasopressor for most patients with sepsis. He shares some data showing an increase in mortality in patients with sepsis during the recent national Norepi shortage!
#SoHM23
Dr. Sevransky shares this large study from last year on balanced crystalloids vs NaCl for critically ill patients. There was no significant difference in outcomes.
#SoHM23
Dr. Sevransky shares several process improvement projects meant to improve sepsis management from across the world.
🔵 Processes with feedback loops for clinicians can help improve sepsis outcomes.
#SoHM23
Dr. Sevransky emphasizes the impact of sepsis in hospitalized patients. Sepsis is the most common reason for dying in the hospital.
#SoHM23
